Your health care provider will require that you full and distribute these declare paperwork to UnitedHealthcare. | To speed claims processing, we use document imaging and optical character recognition (OCR) equipment to read your claims. . AGL Premera Blue Cross of Washington It identifies the members Blue Cross Blue Shield company or national account in order to properly route the claim. ** PPO in a suitcase logo, for eligible PPO members The revenue codes and UB-04 codes are the IP of the American Hospital Association. ABF Healthnow of NY Buffalo YDW Retail OFF Exchange Regence Blue-Cross Blue-Shield: ZBU: Illinois: Blue-Cross Blue-Shield of Illinois: ZBV: Wisconsin: Anthem Blue-Cross Blue-Shield of Wisconsin: ZBW: South Dakota/Iowa: Regence BlueShield - FEP PO Box 857 Lewiston, ID 83501. For services not listed in the RBRVS published annually in the Federal Register, we use Optum's Essential RBRVS (previously known as Ingenix Essential RBRVS and St. Anthony's Complete RBRVS). What is an alpha prefix? The three-character alpha prefix at the beginning of the members identification number is the key element used to identify and correctly route claims. When we process a claim, we coordinate benefits if the member has other primary coverage from another carrier, our health plan, service plan, or government third-party payer. If we cannot resolve the matter through non-binding mediation, either one of us may institute an action in any Superior Court of competent jurisdiction. This is a duplicate of a previously denied claim. CYK BCBS of Georgia Regence BlueShield in accordance with the terms of your Provider contract with Regence. CVM Anthem BCBS of Ohio We can process the claim after we receive that information. Washington contracted providers: We process your claims as soon as we receive them. AFL Anthem Blue Cross of California CUR Healthnow of NY Buffalo AAB BCBS of Michigan DJN BCBS Minnesota | Enter the three digit alphanumeric prefix located on the member's ID card, and the tool provides the correct insurance carrier for you. All Rights Reserved to AMA. DJC Anthem BCBS of Ohio 0000003471 00000 n Electronic Transactions and Claim Payer ID, Resource-based relative value scale (RBRVS), Claims from Non-credentialed contracted providers, federal and Washington state civil rights laws, Subscriber's number and patient suffix number (including plan prefix) assigned by plan as shown on the member's identification card, Number assigned by the clinic for patient. DJR Anthem BCBS of Ohio View the toolkit Claims submission Colorado. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Before implement anything please do your own research. providers: We process your claim as soon as we receive them. Church Street Station. ADA Anthem Blue Cross of California Precertification remains the responsibility of the provider for all Empire HMO network members. Regence Blue Shield in accordance with the terms of your provider contract with Regence. 0000128769 00000 n Find the correct address listed under the type of service received (see explanation). Please The employer group name is usually associated with the alpha prefix of the account specific health insurance type. Regence BlueShield. BCBS Provider Phone Number. 1-800-676-BLUE (2583) (toll free) Blueline voice response unit. You can print and assist the member in completing the form, but it's important to review the instructions included with the form because the patient must complete the form and then sign it. PO Box 52080 If you feel some of our contents are misused please mail us at medicalbilling4u at gmail dot com. Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. DJD BCBS of Nebraska A free form note with an explanation for the corrected/replacement claim, in loop 2300 claim note as: For professional and dental claims: segment NTE01 must contain ADD and segment NET02 must contain the note, for example: NTE*ADD*CORRECTED PROCEDURE CODE (or whatever data element was corrected/changed on the claim), For facility/institutional claims: segment NTE01 must contain UPI and segment NTE02 must contain the note, for example: NTE*UPI*CORRECTED LAB CHARGES (or whatever data element was corrected/changed on the claim), Premera Blue Cross Blue Shield of Alaska Participating (Traditional/Indemnity) and Preferred/BestCare (PPO), Dimensions (HeritagePlus, HeritageSelect, or Global), Validation to ensure that they are HIPAA-compliant, Detailed claim acceptance and rejection reporting. Examples of ID numbers: As a provider servicing out-of-area members, you may find the following tips helpful: ** Ask the member for the most current ID card at every visit. Only a member can request a Level I or Level II Appeal for a non-billing issue, unless the member has completed a release to allow the provider to act as their Representative. Open 24 hours a day, 7 days a week. ADG Anthem BCBS of Ohio Seattle, WA 98104 If submitting a corrected claim on paper, remember to: Obtain Corrected Claim - Standard Cover Sheets at onehealthport.com in the administration simplification claims processing section, or under Forms on our provider website. CWR Anthem Blue Cross of California DJK Empire BCBS 553 0 obj <> endobj Polski | What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Does not determine the reimbursement dollar amount for any particular service (reimbursement is specific to the provider applicable fee schedule). Ideally, we'd like you to submit claims within 60 calendar days of the covered services, but no later than 365 calendar days from the date of submission. Access eContracting to view and sign agreement documents. CYN Highmark BCBS AHC Anthem BCBS of Missouri CWJ BCBS of Alabama 0000013357 00000 n CYQ BCBS of IL AEJ Horizon BCBS of New Jersey HMO products include BlueChoice HMO, Direct Connection HMO, Child Health Plus, BlueChoice HMO/POS and Direct POS. A required waiting period must pass before we can provide benefits for this service. January 19, 2022 by tamble. BCBS Provider Phone Number. DJJ Horizon BCBS of New Jersey AHQ Anthem BCBS of Ohio Get immediate member information by phone or fax . AAY Wellmark BCBS Iowa/South Dakota You can submit claims daily, weekly, or monthly. Use find (Ctrl + F) and enter the prefix to find the BCBS state. QME Retail OFF Exchange ** Members who are part of the FEP will have the letter R in front of their member ID number. You can reach Customer Service by calling 877-342-5258, option 2, or by calling the Customer Service phone number on the back of the member's ID card. QMB SG ON Exchange Note: Some members will remain in Blue Cross of Northeastern Pennsylvania health plans until their coverage renews to Highmark health plans later this year. ** The empty suitcase logo Caused by another party (e.g., slip and fall, medical malpractice, etc. We require that you verify the information about your practice and the networks you participate in at least every 90 days. All people who have BCBS health insurance policy have to make copies of their ID front and back and keep such records on hand. It is important to file a claim with all insurance companies to which the member subscribes. Provider who rendered the service. AGV BCBS of MA Please follow Included with the interest voucher is a summary report detailing CZY BCBS of North Carolina DJE BCBS of Alabama We follow industry standard coding recommendations and guidelines from sources such as the CMS, CPT, and AMA, and other professional organizations and medical societies and colleges. You can also use the Office of Financial Management MyPortal to update your address. color, national origin, age, disability, sex, gender identity, or sexual orientation. The NPI replaces all proprietary (payer-issued) provider identifiers, including Medicare ID numbers (UPINs). claims status, . All services rendered by the same provider for the same patient for the same date of service must be submitted on one claim form. The main identifier for out-of-area members is the alpha prefix. To help you move from paper to electronic claims, follow these steps: Electronic claims can be sent when we are the secondary insurance payer. Complaints received beyond the 365-day timeframe will not be reviewed and the appeals rights pertaining to the issue will be exhausted. Coding toolkit View our clinical edits and model claims editing. You could download the full BCBS prefixes list is here. RGA observes theholiday schedule below. Open 24 hours a day, 7 days a week. In this health insurance plan, alpha prefix is assigned to national accounts. 0000018816 00000 n QMA SG OFF Exchange, PPO YDX Retail ON Exchange If we do not receive a response within the specified period, the claim(s) is denied pending further information. Please request a current ID card from the member. Regence BlueShield serves select counties in the state of Washington and is an Independent Licensee of the Blue Cross and Blue Shield Association. If the card presented has no alpha prefix, follow the instructions on the back of the ID card for inquiries and claim handling. You have to avoid this idea when you have geared up for successfully using the health insurance plan. Use 8 to void a claim billed in error, The initial claim number (in loop 2300, REF01 must contain F8 and REF02 must contain the claim number). (Field not populated for CMS-1500 claims. Instead, deposit the check, circle the claim in question on the Explanation of Payment (EOP) and include a short explanation as to why there was an overpayment. See our FAQs for more claim information and contacts. How do I identify BlueCard Managed Care/POS members? | ABK Carefirst BCBS Maryland Care Management Programs. any missing required substantiating documentation or particular circumstances requiring special treatment. AEV Keystone Health Plan East (IBC) (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10. Our medical staff reviewed this claim and determined that this continued stay doesn't meet the criteria for medical necessity. AAZ Anthem Blue Cross of California AGC BCBS Kansas City Alaska contracted and non-contracted Doing so may cause delays in the handling of your inquiries and claims. CZX Anthem BCBS of Ohio On the other hand, the third character in the prefix is used to find out the product type you have enrolled in. Regence and other health insurers share responsibility for Blue Cross and Blue Shield Federal Employee Program (BCBS FEP) claims information, claims processing and customer service based on the location of where the services were performed and the type Find a doctorContact us Sign in Learn how to contact your local Blue Cross and Blue Shield company, as well as other key areas. When submitting claims, transfer the members identification (ID) number exactly as printed on the ID card. We can process the claim after we receive that information. Eastern WA and Alaska providers submit to Premera. Box 3004 Naperville, IL 60566-9747. you will need to contact Regence to update your account to ensure your claim processes correctly and timely. If you are interested in purchasing a new computer system, ask us for a list of vendors that submit claims to us in the HIPAA standard ANSI 837 format. To send an electronic claim, use the Availity clearinghouse with payer ID RGA01. Where do I determine if a code is covered? All the contents and articles are based on our search and taken from various resources and our knowledge in Medical billing. To cancel or waive your coverage, visit the PEBB Program website using these links: Uniform Medical Plan (UMP) is a self-insured Preferred Provider Organization (PPO) medical plan offered through the Washington State Health Care Authority. YUV SG ON Exchange When this notification has occurred, change the indicator on your claims from (. This service is considered a standard exclusion. AHA BCBS of IL TRS: 711 Fax: 1 (800) 633-0334 Business hours: Monday through Friday: 5 a.m. to 7 p.m. (Pacific) Saturday: 9:30 a.m. to 2 p.m. (Pacific) Note: UMP members do not need to be Costco members to use their mail-order service. . Contact Us. Correspondence. Be sure information lines up correctly within the respective fields (data that overlaps another field/box cannot be read accurately). 1-800-962-2731. Premera Blue Cross complies with applicable federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, If all pertinent information is obtained, the claim(s) will then be processed according to the member's contract benefits. National Correct Coding Initiative (NCCI) editing is followed when applicable. AIE BCBS of Michigan claim and apply additional edits if applicable. We can't process this claim because we haven't received the necessary information we requested from your provider. RBRVS is a method of reimbursement that determines allowable fee amounts based on established unit values as set norms for various medical and surgical procedures, and further based on weights assigned to each procedure code. 4. Use the following codes: In the Original.Ref.Co segment of box 22 enter the original claim number. The member's benefit program contains special provisions for benefits when an injury or condition is: An onset date should be recorded on all accident-related claims. Phone: 1-800-628-3481. (for both professional and facility claims) using claim frequency code 7. The dates-of-service (to and from - also referred to as beginning and ending dates) at a, The code/modifier shown in box 24D of the CMS-1500. User the HIPAA 837 standard claims transaction including the following information: Frequency code of 7 in look 2300, CLM05-3 segment to indicate a corrected/replacement of a previously processed claim. Any suggestions. Retirees and PEBB Continuation Coverage members:Phone: 1 (800) 200-1004TRS: 711Business hours: Monday through Friday 8 a.m. to 4:30 p.m. (Pacific). ** PPOB in a suitcase logo, for PPO members with access to the BlueCard PPO Basic network We are now processing credentialing applications submitted on or before March 14, 2023. Western WA providers submit claims to Regence Blue Shield. ** Remember: Member ID numbers must be reported exactly as shown on the ID card and must not be changed or altered. %%EOF Eligibility, enrollment, and address/name changes. Please make copies of the front and back of the ID card, and pass this key information to your billing staff. We'll coordinate the benefits of the members plan with those of other plans to make certain that the total payments from all plans aren't more than the total allowable expenses. QMF Retail ON Exchange P.O. 0000018650 00000 n Regence Blue-Cross Blue-Shield: HCT BCBS Prefix: Pennsylvania: Highmark Blue-Cross Blue-Shield of Pennsylvania: HCU: Tennessee: Blue-Cross Blue-Shield of Tennessee: HCV: Modifications we make to your contract or to our policy or procedures are not subject to the appeal process unless we made it in violation of your contract or the law. CUQ Blue Shield of California Health . Prompt Pay interest is currently calculated monthly for the previous month's paid claims. The alpha prefix identifies the Blue Plan or National Account to which the member belongs. 0000001762 00000 n Before discussing member claim information, the Customer Service representative must verify the identity of the caller. For other language assistance or translation services, please call the customer service number for . DHA Excellus BCBS Utica PO Box 1106. Lastly mail the completed claim form to the address provided. CVV Anthem Blue Cross of California If you are a clinic or hospital-based physician or other qualified healthcare provider, use a CMS-1500 (02-12) form for claims for professional services and supplies related to: This includes claims for outpatient services and services performed by a hospital-based physician or other qualified healthcare provider. The most commonly occurring codes and messages are listed below. The 2015 member identification prefixes for individual Medicare Advantage plans are listed below. DJT BCBS Minnesota You can use Availity to submit and check the status of all your claims and much more. Stay up to date on what's happening from Bonners Ferry to Boise. Continue to submit paper claims until you are told to stop. AIH Anthem Blue Cross of California 0000006371 00000 n This standard is called the "Birthday Rule.". Saturday and Sunday 6 a.m. to 2 p.m. (Pacific), HealthEquityOnline: HealthEquityPhone: 1 (844) 351-6853TRS: 711Business hours: 24 hours, 7 days a week, Vision Service PlanOnline: Your vision accountPhone: 1 (844) 299-3041Deaf, DeafBlind, Late Deafened and Hard of Hearing members call: 1-800-428-4833Business hours: Monday through Friday 5 a.m. to 8 p.m. (Pacific). If your organization is contracted with Premera, most practitioners must be credentialed, with the exception of hospital-based practitioners. https://www.bcnepa.com/Providers/providerrelations/ReferenceGuides/AlphaPrefixList.pdf. We can process the claim after we receive that information. Claims filing information and provider service phone numbers are available in the December, January and February Provider Bulletins. 2023 Regence BlueShield. If member returns the call and the information is obtained, claims will be processed. | Please refer to your electronic billing manual for specific formatting for electronic claims. ADJ Anthem BCBS of Missouri Portugus | ADE BCBS of IL Asthma. These charges are included in the main anesthesia service. ALR AR BC AR, PO Box 2181 , Little Rock , AR , 72203-2180 888-847-1400, AMU RI BCRI, 444 Westminister St , Providence , RI , 02903-3279 401-831-7300, AMZ KY BC KY, POB 37690 , Louisville , KY , 40233 800-925-0135, AON IL BC IL, POB 1364 , Chicago , IL , 60690 800-972-8088, APT DE BC DE, POB 8830 , Wilmington , DE , 19899-8830 800-342-2221 Box 805107 Chicago, IL 60680-4112. Pension & Retirement. AET Anthem Blue Cross of California Download the bcbs pdf document which has been at the bottom of the post and you could find prefix for OHIO too. CVG BCBS of Florida Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. We can't process this claim until the questionnaire we recently sent the member is completed and returned to us. You may have invested in the account specific alpha prefix health insurance plan from BSBS at this time. 800-676-2583. View the instructions for verifying your information and notifying us of changes. This plan allows you to self-refer. Members: Log in/register at MyBlue Customer eService, Regence Blue Cross Blue Shield of Oregon - FEPPO Box 31105Salt Lake City, UT 84131, Regence Blue Cross Blue Shield of Oregon - FEPPO Box 1269Portland, OR 97207, Find Premera Blue Cross & The Regence Group Common Alpha Plan Prefixes Last updated: 09/01/2016 Premera Blue Cross & Premera Blue Cross/NASCO Prefixes Western WA providers submit claims to Regence Blue Shield. They can take note of bcbs alpha prefix online in detail and gain knowledge of how to choose the right alpha prefix. . Once the IQ is returned, all claims are reviewed and processed based on the information supplied. The National Uniform Claim Committee (NUCC) has developed a 1500 Reference Instruction Manual detailing how to complete the claim form to help nationally standardize how the form is completed. AHI BCBS of Rhode Island Washington Help Center: Important contact information for Premera Blue Cross, and Regence BlueShield. This prefix is the part of the distinctive identification number. Franais | Once the claim is found, you can click on original EOP view to pull up this information. In these cases, please don't return the check to us. Regence BlueShield of Idaho offers health and dental coverage to 142,000 members throughout the state. How do I identify international members? 0000018383 00000 n AAU Blue Shield of California BET PA BC PA, 120 Fifth Ave , Pittsburgh , PA , 15222-3099 412-544-7000, BFM PA BC PA Highmark, POB 176 , Pittsburgh , PA , 15230-0176 866-316-6339, BGH AL BCBS of Alabama, POB 995 , Birmingham , AL , 35298 205-988-2213, BGP MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237, BHP PA BC PA, POB 778988 , Harrisburg , PA , 17177-8988 800-222-3341, BIM MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237, BMI IN BCBS of Indiana, 120 Monument Circle , Indianapolis , IN , 46204 317-488-6000, BOG MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237 DJP BCBS of Nebraska If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. Mail this claim to: Regence BlueShieldPO Box 1106Lewiston, Idaho 83501 Or Fax claim to: (888) 606-6582 FORM PD020-WA Page 2 of 3 (Eff. The maximum limit has been met for this benefit. AEX BCBS of IL Prefix Plan Name, AAA BCBS of Alabama startxref Idaho Regence BlueShield of Idaho PO Box 31603 Salt Lake City, UT 84131 Illinois BlueCross BlueShield of Illinois PO Box 1364 Chicago, IL 60690 This alpha prefix of BCBS plays the major role behind the proper way to claim the health insurance plan without delay and difficulty. 4. ABQ Blue Cross of Idaho (Boise) AGY BCBS of South Carolina Prefix State/Area Plan Type Plan Name Provider and member service CMS contract, VOF NY MA HMO MediBlue HMO 1-800-499-9554 H3370 AGU Carefirst BCBS Maryland ACQ BCBS of Georgia From there, you will be directed to a new site; at this site, enter in your login information. AHJ Independence Blue Cross the instructions to determine where to send claims or correspondence. Box 1106Lewiston, ID 83501-1106 Fax: 1 (877) 357-3418 If you have questions about submitting a claim for services outside the U.S., call UMP Customer Service. Practitioners who arent credentialed may have their claims returned until they submit a complete credentialing application. We are unable to quote a benefit by a code. ABB BCBS of IL CYJ Horizon BCBS of New Jersey To help your office complete year-end accounting, each December we'll issue you a check for the accrued interest we owe you, even if the amount is below the TINs are still a required element for claims. There is a balance due to us at the end of the payment cycle. CZC Anthem BCBS of Ohio AHX Horizon BCBS of New Jersey We haven't received the information. Uniform Medical Plan (UMP) offers you five different health plans through Washington state's Public Employees Benefits Board (PEBB). Use search function and put your comment any alpha prefix not found here. YDM SG Off Exchange We can process the claim after we receive that information. See our FAQs for more claim information and contacts. (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) If your request for mediation is timely, both parties must agree upon a mediator. ADQ Independence Blue Cross They will be satisfied when they properly use this insurance plan and fulfil overall requirements on the prompt assistance for claiming the insurance.
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